Chronic reactive multifocal osteomyelitis (CRMO) - mandible

Case contributed by Dr Jeremy Jones


Left sided jaw swelling. Some pain on eating. No other joint pain.

Patient Data

Age: 10 years
Gender: Female

Asymmetric mandible with expansion and increased sclerosis of the left mandibular body and ramus with associated periosteal reaction.

There is expansion of the left mandibular body. T2 hyperintense and T1 hypointense. Surrounding soft-tissue edema, but no soft tissue mass. No other lesions.

Case Discussion

The differential in this case is between a primary agressive bone tumor (e.g. Ewing sarcoma) or a process such as LCH or an inflammatory osteitis (e.g. CRMO).

A whole body MRI is useful to determine whether there are other lesions that might narrow the differential or offer another site for biopsy.

In this case, there were no other abnormalities.

A biopsy was performed that excluded an underlying neoplastic process and the diagnosis of CRMO was made. Treatment resulted in a reduction of the periostotic inflammation and improved pain control.

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Case information

rID: 56405
Published: 30th Oct 2017
Last edited: 14th Aug 2019
System: Paediatrics
Inclusion in quiz mode: Included

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